marshall island women focus group
Summary
The Marshall Islander focus group was held in Springdale , Arkansas , on February 23, 2004 . The focus group consisted of seven Marshall Island women; among them were several "madam pastors" within the Marshall Island community. As pastors are considered to be prestigious members of the Marshall Island community, they have considerable access and insight into Marshall Islanders who reside in Northwest Arkansas , in regard to their health care concerns.
Participants for the focus group were selected by Carmen S. Chong Gum of the Northwest Arkansas Multicultural Center . Ms. Chong Gum facilitated the focus group and conducted the session in Marshallese. Two staff members from the University of Arkansas Social Work Research Center also facilitated/observed the focus group.
Summary of Major Themes
Northwest Arkansas has the highest concentrated population of Marshall Islanders, outside of their homeland (Republic of the Marshall Islands ). Given the unprecedented immigration of Marshall Islanders to Northwest Arkansas, their general lack of assimilation (to date), into the mainstream culture, and their distinct health care needs, a focus group consisting of salient members of the Marshall Islander community was conducted in order to gather information in regard to Marshall Islanders' health care needs, from their own perspective.
Accessing Health Care Services
Accessing needed health care services was identified by a majority of the focus group participants as being a problematic concern. Language and cultural barriers, lack of qualified Marshallese translators, and lack of awareness of available health care clinics and services, were the reasons most frequently cited by members of the focus group in regard to the difficulties that many Marshall Islanders experience in attempting to access needed health care services.
Medical Care Costs
Similar to the plight of a majority of American citizens, members of the Marshall Islander community are also deeply concerned in regard to medical care costs. While part of this concern appears to be related to economically sensitive issues (e.g. , lack of affordable health care insurance, employment status, money needed for co-payments and deductibles) Marshall Islanders' attitudes about the affordability of basic health care services was shaped by the universal availability of subsidized health care services within their homeland. One of the members of the focus group described the dilemma that many Marshall Islanders confront when faced with money needed for health care costs in Northwest Arkansas :
"In the Marshall Islands the amount of money from you paycheck is enough to buy your necessities because you have a chance to find help, but when you come here, your paycheck is spent to pay everything from the littlest trash, to the water and sewer, and everything else. "
Lack of knowledge in regard to medical care services available in Northwest Arkansas, cost of health care services, and cultural experiences derived from a low cost, easily accessible health care system in the Republic of Marshall Islands, appear to cumulatively contribute to the difficulties many Marshall Islanders experience in accessing health care services in the United States.
Health Care Concerns
Participants in the focus group identified the following health care concerns which impact the Marshallese community in Northwest Arkansas : diabetes, hypertension, stress associated with migration, obesity, nutritional concerns, and lack of exercise. While the members of the focus group acknowledged that many of the illnesses that Marshall Islanders exhibit were brought with them from their country of origin, the stress associated with migration clearly appears to play a role in their health status. Members of the focus group characterized the challenges associated with immigration in the following manner:
"The doctor used the word stress, but I think he should have used like
you body is experiencing many new things, new food. "
Attitudes towards Health Care
Attitudes towards accessing health care appear to be an important consideration in Marshall Islander's ability to manage their own health. While communication limitations, cost of health care, and accessibility of health care clinics were frequently cited as barriers to accessing needed health care services, there was also acknowledgement that Marshall Islanders attitudes towards seeking health care services is an important consideration.
"But, yes it is true, sometimes because we don't understand and we don't know, and sometimes because we have a habit, some of us, habit of procrastination, we are used to saying yes we will go, and we don't go, some of us still have this habit and since it is different here than our Islands. "
Another focus group member identified the following reasons why Marshall Islanders may not consistently access health care services:
"and another thing maybe about our ways of living, how we are brought up, we are not too aggressive to go forward with everything. It is a problem with us feeling ashamed and embarrassed. "
Recommendations
Participants of the focus group offered the following recommendations in order to improve the quality and accessibility of health care services for Marshall Islanders residing in Northwest Arkansas:
- Provide information and eligibility requirements in order to access health care and insurance (e.g. , Medicare, Medicaid).
- Translation services need to be available to Marshall Islanders, in all health care settings.
- Provide wellness education to the Marshallese community in order to promote healthy behaviors (nutrition, exercise, adequate amount of sleep), and health management education.
- Increase awareness of available health care services.
- Educate healthcare providers and leaders in the community about the health needs of the Marshall Island community.